In this context, the intermittent use of mask + HFNC (alternating with proning, during mobilisation, as a rescue in desaturation episodes, a bridge to intubation or a last resort for patients with ...ceiling of care) has filled a niche, being less demanding than NIV by face mask, while maintaining benefits of HFNC over conventional oxygen treatment. ...studies are needed regarding oxygen delivery in severe COVID-19. Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies.
This study explored factors associated with interest in taking PrEP among men who have sex with men (MSM) attending HIV testing venues in Sweden. Data from 658 HIV-negative respondents, surveyed by a ...questionnaire at six sites, were analyzed descriptively and by univariable and multivariable logistic regression. A total of 453 (68.8%) of the respondents expressed interest in taking PrEP. Reporting self-perceived risk of HIV acquisition as moderate or high, reporting ≥ 5 partners for condomless anal intercourse during the past year, and reporting hard drug use during the past year were independently associated with interest in taking PrEP. However, an aggregated variable of self-reported rectal gonorrhea, rectal chlamydia, or syphilis infection during the past year was not associated with interest in taking PrEP. Overall, Swedish MSM were well-informed regarding PrEP, and interest in taking PrEP was positively associated with sexual risk indicators.
HIV self-testing (HIVST) has been found to have high acceptability among men who have sex with men (MSM) internationally and might contribute to increase testing frequencies, but many countries, ...including Sweden, lack policies for using HIVST.
To examine interest to use and willingness to pay for HIVST, and associated factors, among MSM attending HIV testing venues in Sweden.
This cross-sectional study analyzed data from a self-administered survey, consisting of 33 questions, collected at six HIV testing venues in Sweden in 2018. The sample consisted of sexually active men who have sex with men, aged ≥ 18 years, and not diagnosed with HIV. Data were analyzed descriptively and by univariable and multivariable logistic regression.
Among 663 participants (median age 33 years), 436 respondents (65.8%) expressed interest to use HIVST. Among those interested, less than half, 205 (47.0%), were willing to pay for HIVST. Being interested in HIVST was found to be negatively associated with being in the 55 years or older age group (AOR 0.31, CI 0.14-0.71), and having had syphilis, rectal chlamydia, or rectal gonorrhea in the preceding 12 months (AOR 0.56, CI 0.32-0.99). In the sample of MSM interested in HIVST, willingness to pay was positively associated with being in the age groups 35-44 years (AOR 2.94, CI 1.40-6.21), 45-54 years (AOR 2.82, CI 1.16-6.90), and 55 years or above (AOR 3.90, CI 1.19-12.81), and negatively associated with being single (AOR 0.56, CI 0.36-0.88).
This study found high interest for HIVST in a sample of MSM in Sweden. However, HIVST offered at a cost is likely to negatively affect uptake among MSM broadly, compared with free availability.
The diagnosis of infectious diseases and the duration of antibiotic therapies are generally based on empirical rules. Studies implicate that the use biological markers can be used as a reliable ...method to shorten antibiotic therapies. The return of appetite is a clinical aspect of recovery from an infection that may be used to guide antibiotic therapies.
To compare changes in appetite and daily energy intake with changes in CRP-levels in patients recovering from an infection.
Observational study using a consecutive sample of patients admitted to the unit for infectious diseases at a University Hospital in Sweden, February to April 2014. Energy intake, CRP-levels and appetite were recorded daily. Energy intake was calculated using estimated energy contents. Appetite was measured using a validated visual analogue scale. Changes in daily energy intakes, CRP-levels and appetite were analysed.
49 patients (51% men) were included in the analysis from the overall population of 256 patients. During the length of the stay (median 3 days) CRP-levels fell in 92% of the patients (p<0.001), daily energy intake increased in 73% (median intake +6381 kJ/day, p<0.001) and appetite increased in 55% of the patients (p = 0.181). VAS-estimations of appetite augmented in 55%, decreased in 41% and were equal in 5% of the patients (p = 0.181). There was a non-significant difference in the within-subject variances in daily energy intake between female and male patients but not in other subsets.
We found a significantly increase in the daily energy intake but not in self-estimated appetite in patients recovering from an infection. We suggest measuring the daily energy intake as a complement to other biological and clinical markers among inpatients to assess treatment effect.
Limited data are available on the pathogenesis of HIV-2, and the evolution of Env molecular properties during disease progression is not fully elucidated. We investigated the intra-patient evolution ...of molecular properties of HIV-2 Env regions (V1-C3) during the asymptomatic, treatment-naïve phase of the infection in 16 study participants, stratified into faster or slower progressors. Most notably, the rate of change in the number of potential N-linked glycosylation sites (PNGS) within the Env (V1-C3) regions differed between progressor groups. With declining CD4
T-cell levels, slower progressors showed, on average, a decrease in the number of PNGSs, while faster progressors showed no significant change. Furthermore, diversity increased significantly with time in faster progressors, whereas no such change was observed in slower progressors. No differences were identified between the progressor groups in the evolution of length or charge of the analyzed Env regions. Predicted virus CXCR4 use was rare and did not emerge as a dominating viral population during the studied disease course (median 7.9 years, interquartile range IQR: 5.2-14.0) in either progressor groups. Further work building on our observations may explain molecular hallmarks of HIV-2 disease progression and differences in pathogenesis between HIV-1 and HIV-2.
With increased access to antiretroviral treatment (ART) in sub-Saharan Africa emergence of HIV-1 pretreatment drug resistance constitutes a serious risk. This may lead to rapid virological failure in ...subjects initiating ART, and mother-to-child transmission despite prophylaxis.
Treatment-naïve pregnant women from four antenatal care clinics in Bissau, Guinea-Bissau, were enrolled from October 2016 to November 2017. Genotypic resistance testing and phylogenetic subtype analysis was performed on 48 specimens.
Forty eight women met the survey inclusion criteria. All specimens were successfully amplified and genotyped. Specimens from five women were associated with HIV-1 drug resistance mutations. Four carried mutations exclusively linked to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (K103N, K103N/S) and one carried mutations to both NNRTIs (G190S, K101E) and nucleoside reverse transcriptase inhibitors (NRTIs) (M184V). These results corresponded to 10.4% (95% CI: 4.5-22.2%), 2.1% (95% CI: 0.4-10.9%) and 0% (95% CI: 0.0-7.4%) drug resistance mutations to NNRTIs, NRTIs and protease inhibitors, respectively. HIV-1 circulating recombinant form 02AG was most commonly found, followed by HIV-1 sub-subtype A3. Subtype/CRF was not associated with drug resistance mutations.
Our study reports a 10.4% prevalence of pretreatment drug resistance to NNRTIs in HIV-1-infected pregnant women in the capital Bissau, Guinea Bissau. Since NNRTIs are part of first-line ART in the country, baseline resistance screenings or adjustment of national treatment guidelines should be considered as antiretroviral treatment programs are scaled up.
The HIV-1 epidemic in West Africa has been dominated by subtype A and the recombinant form CRF02_AG. Little is known about the origins and the evolutionary history of HIV-1 in this region. We ...employed Maximum likelihood and Bayesian methods in combination with temporal and spatial information to reconstruct the HIV-1 subtype distribution, demographic history and migration patterns over time in Guinea-Bissau, West Africa. We found that CRF02_AG and subsubtype A3 were the dominant forms of HIV-1 in Guinea-Bissau and that they were introduced into the country on at least six different occasions between 1976 and 1981. These estimates also corresponded well with the first reported HIV-1 cases in Guinea-Bissau. Migration analyses suggested that (1) the HIV-1 epidemic started in the capital Bissau and then dispersed into more rural areas, and (2) the epidemic in Guinea-Bissau was connected to both Cameroon and Mali. This is the first study that describes the HIV-1 molecular epidemiology in a West African country by combining the results of subtype distribution with analyses of epidemic origin and epidemiological linkage between locations. The multiple introductions of HIV-1 into Guinea-Bissau, during a short time-period of five years, coincided with and were likely influenced by the major immigration wave into the country that followed the end of the independence war (1963-1974).
Recently, metabolomics studies have suggested that the neurotransmitter γ-amino butyric acid (GABA) may modulate C. difficile infection (CDI) pathogenesis. In the present study, we investigated the ...association between GABA-modulating pharmaceuticals and CDI development.
In July-December 2013, we performed a matched, retrospective case-control study in Skåne county, Sweden, to assess the association between the use of GABA-modulators (defined as regular use of at least one of the following: zolpidem, zopiclone, benzodiazepines, gabapentin, pregabalin or baclofen) and CDI. Multivariate regression models, adjusted for known risk factors for CDI, were fitted to assess the associations and a propensity score-adjusted analysis was performed.
The study included 292 cases and 292 matched controls. In a multivariate regression model only recent antibiotic use (clindamycin, cephalosporins and fluoroquinolones) and nursing home residency was significantly associated with CDI. The regular use of any GABA-modulator was not associated with CDI (OR = 1.07, 95%CI 0.69-1.66, p = 0.76). The association between regular use of the selective GABA-agonist zolpidem and CDI trended towards significance (OR = 2.31, 95%CI 0.91-5.86, p = 0.078). These associations remained when only cases treated with antibiotics were included. Corresponding findings for zolpidem was observed in a propensity-score adjusted analysis (OR = 2.52, 95% CI 0.91-6.97, p = 0.075). Severe initial CDI was significantly associated with CDI recurrence (OR = 3.77, 95% CU 1.20-11.86, p = 0.023).
This study did not identify a general association between GABA-modulators and CDI. A trend towards a significant association between zolpidem and CDI was observed, an association that should be re-assessed in a study appropriately powered for this particular hypothesis.
The aim of the study was to investigate the prevalence of faecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae among residents living in nursing homes and to ...compare it with a corresponding group of elderly people living in their own homes.
A total of 160 persons participated in the study between February and April 2014, 91 were residents in nursing homes (n = 10) and the remaining 69 were elderly living in their own homes. In addition to performing faecal samples, all participants answered a standardized questionnaire regarding known risk factors for ESBL-carriage.
There was no significant difference between the groups, as 10 of the 91 (11%) residents from nursing homes were ESBL-carriers compared with 6 of 69 (8,7%) elderly living in their own homes. There was no significant difference between the groups. The total prevalence was 10%. A univariate analysis revealed that the only studied risk factor significantly associated with ESBL-carriage was recent foreign travel (p = 0,017). All ESBL-positive isolates were Escherichia coli and there was a high degree of co-resistance to other antibiotics. All isolates (n = 17) were susceptible to imipenem and amikacin.
Residents of nursing homes as well as elderly living in their own homes have high rates of faecal carriage of ESBL-producing bacteria. These findings may affect the choice of empirical antibiotic treatment of severe infections in older adults.
Humans, independent on where they live, are exposed to complex and various mixtures of chemicals, including persistent organic pollutants (POPs). The variability of the exposure depends on sources of ...the chemicals and is influenced by e.g. geography, social and cultural heritage. While exposures to POPs are frequently studied in populations from developed industrial countries, very little is known on levels and trends of POPs in developing countries, especially in Africa.
The aim of the present study was to investigate levels and temporal trends of POPs in adults from Guinea-Bissau.
Serum samples were obtained from an open cohort of police officers in Guinea-Bissau. Repeated samples from 33 individuals were obtained at five time points between 1990 and 2007, in all 147 samples. Pooled serum samples were extracted and cleaned-up prior to analysis by gas chromatography and mass spectrometry. The concentration of 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (4,4′-DDT) and its metabolites, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and hexachlorocyclohexanes (HCHs) were determined.
The major POP found in all samples was 1,1-dichloro-2,2-bis(4-chlorophenyl)ethene (4,4′-DDE) followed by 4,4′-DDT. 4,4′-DDE, 4,4′-DDT, PCBs and β- and γ-HCH were significantly decreasing over time. The PBDEs were found at low concentrations, with an increasing temporal trend for BDE-153.
National and international management may be behind the observed decreased organohalogen compound concentrations in humans from Guinea-Bissau from the early 1990's and onwards, similarly to the development of these compounds in humans from industrial countries. In contrast, PBDEs follow a trend of increasing concentrations even though at low levels.
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